Nursing Education and Strategies to Support Diverse Learning Needs of Students

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Strategies to Support Diverse Learning Needs of Students In Nursing Education

Nursing Education and Strategies to Support Diverse Learning Needs of Students

What are Strategies to Support Diverse Learning Needs of Students In Nursing, Geriatric Nursing and Modification in Nursing Education Strategies to Support Diverse Learning Needs of Students, Profile of Contemporary Nursing Students In Nursing Education, Enrollment Demographics, Bridging Differences in Generations In Nursing Education, Generation X or “Baby Busters”, Millennials or Generation Y, Generation Z, Racial and Ethnic Diversity, Men in Nursing, Veterans Entering Nursing, First Generation College Students, Barriers That Affect the Success of Diverse Students, Lack of Financial Resources, Lack of Rigorous Academic Preparation, Lack of Language Skills, Lack of Diverse Faculty.

What are Strategies to Support Diverse Learning Needs of Students In Nursing

    Students in today's college classrooms represent a wide array of diversity in learning needs and expectations. Nursing faculty are not only faced with the challenges of teaching students from varied backgrounds, of varied ages, and with an array of life experiences, but also are faced with the challenges of teaching students with significant technological experiences and demands on their time. 

    Faculty must continually think creatively as they develop interactive learning environments to foster students' successful integration into an every changing and increasingly diverse health care system. This chapter presents a brief profile of today's nursing students and describes the unique demographic characteristics of students, along with strategies to improve success in nursing programs. 

    Also, the chapter provides information about students' learning styles, thinking skills, and cognitive abilities. Specific teaching and learning strategies related to students' diverse needs are presented to enable faculty to plan for effective and successful learning experiences for all students and help prepare them for transition into practice.

Geriatric Nursing and Modification in Nursing Education Strategies to Support Diverse Learning Needs of Students

    The rapid growth of older populations and a significant increase in ethnic and racial diversity will be realized in the United States from now to 2060 (National Population Projections, 2014). Although the current rate of growth can only be predicated based on an estimate of net international migration, census trends depict growing diversity in the composition of our many communities. 

    In fact, more than 76 nationalities are represented in the United States' 307 million households, and more than 40 languages are spoken (US Census Bureau, 2011). 

    With increasing data collection regarding the nation's diverse populations there has been special, and necessary, interest paid to meeting the diverse health care needs of its citizens, not the least of which is the shortage of diversity in the health care workforce (American Association of Colleges of Nursing, 2014b). 

    Overall, the definitive Institute of Medicine's (IOM) extensive report, In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce (2004), paints a broad picture of the benefits of greater diversity among health professionals, the need for strategies to increase diversity in all the health professions, the promotion of both quality and quantity of interactions across diverse groups, the importance of an educational culture that promotes the exchange of diverse ideas, the challenge to reframe our thinking about unbalanced educational representations, the reduction of financial barriers for minority health care education, and the promotion to all stakeholders for comprehensive support of diversification strategies.

Profile of Contemporary Nursing Students In Nursing Education

    The profile of nursing students in the twenty-first century is markedly different from that of the prior century. There are disparities in secondary education preparation for higher learning, student demographic differences, gender shifts, generational differences, and increasing racial and ethnic diversity. 

    Meanwhile student and faculty age differentials are widening and faculty composition is less representative of the wider population demographic. Planning effective learning experiences to meet the needs of students has implications for nursing programs as the development of curricula is contemplated and necessary resources are determined to support the academic performance of all students.

Enrollment Demographics 

 The Bureau of Labor Statistics (2014) reports that the registered nurse (RN) employment opportunities are expected to grow more than the average for all occupations at a rate of 19% from 2012 to 2022.

    Therefore, there can be little doubt that nursing is a sought-after career, even as a second or late career choice. Findings from the National League for Nursing (NLN) Annual Survey of Schools for Academic Year 2011–2012 (2013) provide assurance that the goal of a nursing degree continues to grow for all age groups, genders, minorities, and program types. 

    The percentage of baccalaureate students older than 30 were enrolled at the rate of 16%, whereas the percentage of other prelicensure students older than 30 enrolled in associate degree and diploma programs remains high at 50% and 33%, respectively. 

    Degree transition and graduate programs in nursing are also well represented by students older than 30: RN bachelor of science in nursing students were 71% of enrollees, master of science in nursing students were 67%, and doctoral students were 83% of enrollees. 

    This wide age diversity among students in nursing offers unique challenges to nurse educators when these students are mixed in classrooms. The college student population is also becoming more representative of the increasing cultural diversity that exists in American society. 

    The percentage of minority students enrolled in prelicensure RN programs as reported to the National League for Nursing (2013) by race and ethnicity increased from a total of 15.7% in 1993 to 32.5% in 2012. Also, because of the positive career outlook, more men are enrolling in basic prelicensure programs with reported increases from 1992 to 2012 of 10% to 15% (National League for Nursing, 2013).

    Competition for admission into baccalaureate, associate, and Master's degree nursing schools remains significant, which also shifts the demographic profile of the student nurse. Of all qualified applications submitted to prelicensure nursing schools in fall 2012, only 39% were accepted (NLN, 2012). 

    In a 2014 report, the American Association of Colleges of Nursing (AACN) stated that “although nursing student enrollment increased forward more than 53,000 qualified applicants to entry-level nursing programs were turned away” (American Association of Colleges of Nursing, 2014a). 

    The major reasons for turning away qualified applicants, as reported by nursing schools, include a shortage of faculty, insufficient clinical teaching sites, limited classroom space, lack of preceptors, limited funding, and budget cuts (American Association of Colleges of Nursing, 2014a; NLN, 2012). 

    At the same time, faculty and administrators are challenged to continue to recruit qualified, diverse student bodies and to maintain high academic standards and outcomes despite a critical shortage of resources.

    The IOM report (2011), The Future of Nursing: Leading Change, Advancing Health, has been hailed as a landmark reference that directs vital attention to the development of a diverse nursing workforce to prepare the nation to meet present and future health care challenges. To achieve this goal, nursing programs need to recruit and retain students who represent the increasing diversity of the US population.

Bridging Differences in Generations In Nursing Education

    Nursing students have a singular goal to graduate and enter practice as a nursing professional; Nursing faculty are similarly focused on preparing and graduating competent nurses to enter the profession of nursing. 

    Although students and faculty can agree on a similar focus, the lens through which each group views the teaching and learning experience is often considered based on subjective differences, such as age and generation cohort, gender, education level and background, economic resources, race, ethnicity, or lived experiences.

    Age and generation cohort differences can create both implicit and explicit disconnections between students and faculty. With information extrapolated from enrollment in all types of nursing programs (National League for Nursing, 2013), we find that 50% or more of enrolled students are 30 years of age or younger. 

    Contrast these younger student age groups with results from the 2013 Human Resources and Services Administration (HRSA) report where faculty older than 30 represent 97% of the nursing education workforce; 72% of nurse faculty respondents to the HRSA 2013 study were 50 years of age or older.

    Students in nursing classrooms represent a variety of generations, each with unique perspectives and learning needs. Hence, the generation of the student will likely be different from that of the faculty. Aside from distinct age comparisons, generational differences present challenges for nursing students and the faculty alike.

    Although it is easy for both groups to make quick judgments concerning differences in values, attitudes, beliefs, and role expectations, a commitment by faculty to facilitate dialogue and initiatives to close the gap in value orientations create a professional commitment to support learning for all students (Bonaduce & Quigley, 2011; Hutchison, Brown, & Longworth, 2012). 

    Students in education environments where generational diversity is accepted and supported will find themselves prepared to create better health care work environments. These workplaces will benefit from the Graduates' comprehensive exposure to multiple generations and diverse backgrounds as they work with peers, health care team members, and patients (Hendricks & Cope, 2012).

Generation X or “Baby Busters”

    Generation X represents a smaller cohort (50 million) of people born between 1965 and 1976 (US Census Bureau, 2011). They are more diverse in race and ethnicity than previous generations, but not as diverse as their counterpart Millennials. These are children of Baby Boomers and their work ethics and loyalties differ from those of their parents. 

    Many are children of divorced parents or working parents, and are referred to as latchkey kids. This cohort “has learned how to manage their own time, set their own limits and get their work completed without supervision” (Hendricks & Cope, 2012, p. 719).

    This generation was the first to demonstrate a need for work–life balance and self-sufficiency, coining the phrase “what's in it for me?” Generation Xers are comfortable with change and technology, as their members have participated in the development of Google, YouTube, and Amazon (Hendricks & Cope, 2012).

Millennials or Generation Y

    Millennials, or Generation Y, are persons born between the late 1970s and middle to late 1990s. They are described as “the next great Generation” and outnumber any previous generation at around 76 million strong (US Census Bureau, 2011). 

    Millennials grew up as highly valued children of the Generation X “baby busters” and are generally described as optimistic, team-oriented, high achieving rule-followers. Aptitude test scores among this group have risen across all grade levels, and the pressure to succeed has risen likewise (Dols, Landrum, & Wieck, 2010). 

    Millennials characteristically have good relationships with their parents and families and share their interests in music and travel. Parents of Millennials involved their children in academic and sports activities at younger ages to prepare them for success. 

    Millennials are accustomed to living highly structured lives planned by their parents and have had very little free time. By the time they reach college, they have learned how to work with others and be a member of a team (Dols et al., 2010; Hendricks & Cope, 2012; Howe, 2010; Stanley, 2010).

    Implications for nurse educators in teaching this generation include providing immediate feedback and structure in the classroom, providing for the safety of the students on campus and in clinical sites, and providing opportunities for service and giving back to their communities. Millennial learners are technologically savvy and comfortable with multitasking, and value doing rather than knowing.

    They are “digital natives,” having grown up with technology (Wolff, Ratner, Robinson, Oliffe, & Hall, 2010); However, this can sometimes be a barrier to critical thinking, as students may have difficulties refining their abilities to focus on priority issues. Millennials as a group are more diverse than previous generations, with 36% being nonwhite or Hispanic (US Census Bureau, 2011; Wolff et al., 2010).

    The parents of this generation expect that their children's schools and universities will reflect diversity and thus provide a richer learning experience.

Generation Z

    The newest cohort of people born after the Millennial Generation is Generation Z, which represents those born from the middle to late 1990s to the present day. Other names proposed for this cohort include but are not limited to the generation, Gen Tech, Gen Wii, Gen Next, and Plurals. 

    Most important to note is that this cohort is coming of age and advancing into college programs and careers, thereby presenting yet another group of distinctly technologically focused students with contexts for learning different from educators (McCrindle & Wolfinger, 2014; Raphelson, 2014).

    The implications of such generational demographics should be significant to nursing faculty and the profession as a whole. Teaching strategies that successfully engage the Millennial learner need to be interactive, group focused, objective, and experiential (Baker, 2010; Hutchison et al., 2012; Igbo et al., 2011; Wolff et al., 2010). 

    Older students who are returning to school with multiple role responsibilities may require support resources such as tutoring, remediation, day care, and the opportunity for part-time study and entirely different learning strategies. Students may find that online courses help facilitate their ability to meet multiple responsibilities while seeking their education.

    Incorporating a variety of teaching strategies, such as the selectively used teacher-centered lecture as well as entertaining, interactive, web-based media that appeals to multigenerational students recognizes both groups' learning needs and preferences. Faculty can benefit from the diverse generational component in their classes, and draw on the diverse perspectives represented among learners. 

    Faculty must prepare for an increasingly diverse student body by closely examining the changing demographics of their student body, the adequacy of support services for the adult learner in their institution, and the flexibility of nursing curricula in their program (Baker, 2010; Hutchison et al ., 2012; Igbo et al., 2011;

Racial and Ethnic Diversity

    There continues to be lack of ethnic and racial diversity in the nursing profession. Even with concerted efforts to increase the diversity of the US nursing workforce, at 75% it still remains predominantly White in composition (Human Resources and Services Administration, 2013b). 

    According to the Human Resources and Services Administration (2013a), 9.9% of the nursing workforce reported themselves as African American; 4.8%, Hispanic; and 8.2%, Asian. Similarly, despite an emphasis on recruitment of ethnically diverse students, minority students enrolled in schools of nursing continue to be underrepresented. 

    The NLN (2012) reported that of all nursing students enrolled in prelicensure nursing programs, 12.9% reported themselves as African American; 6.8%, Hispanic; 5.6%, Asian; and 0.8%, American Indian, meaning approximately 26% of the students in prelicensure programs represented racial and ethnic diversity. 

    These numbers remained relatively stable for the following 2 years. The nursing profession is challenged to recruit and retain students representing diversity. Chapter 16 provides an in-depth discussion on creating an inclusive learning environment and supporting the learning needs of diverse students.

Men in Nursing

    According to the Annual Survey of Schools (NLN, 2013), men comprise 11.4% of students in baccalaureate programs, 9.9% of Master's students, and 9% of students in doctoral programs. Men in doctoral nursing programs compose 6.8% of students in research-focused programs and 9.4% of students in practice-focused programs (American Association of College of Nursing, 2012). 

    While the data shows encouraging trends, there remains an imbalance in gender enrollment in nursing programs as well as evidence of male students not completing their respective educational programs. 

    Various studies indicate the possibility of barriers in the professional schools that lead male students to feel marginalized and, in some cases, even to abandon their career choice before graduating (Burke, 2011; Rajacich, Kane, Williston, & Cameron, 2013).

    Men in nursing currently represent approximately 7% of the nurse population according to the National Nursing Workforce Survey of Registered Nurses (Budden, Zhong, Moulton, & Cimiotti, 2013) and nearly 15% of the prelicensure student population (NLN, 2013).

    Numbers of men choosing to pursue nursing continue to grow through increased enrollment in schools of nursing because of the job flexibility and varied career opportunities (Burke, 2011; Rajacich et al., 2013). 

    As previously noted, male students may feel marginalized and may abandon the field before graduation (Burke, 2011; Rajacich et al., 2013; MacWilliams, Schmidt, & Bleich, 2013). Given the paucity of current references, newer research in the study of men in nursing is needed to highlight the issues and inherent continued struggles of male nursing students. 

    Nursing faculty should be compelled to recognize barriers perceived by men in schools of nursing and seek to rectify them. Male nursing students present with their own perceptions and needs, whereby the use of sexist language in the classroom and textbooks creates a less inviting classroom for male students, including the determination that curricula in nursing programs are designed for female learners (Burke, 2011; Rajacich et al., 2013; MacWilliams et al., 2013), especially in relation to testing, classroom lecture and discussion, and course structure. 

    Tape recorded interviews and diaries written by the participants to identify factors influencing male nursing students' course completion determined that the presence of male role models in nursing education was important for student support and inspiration. However, a lack of these role models creates self-doubt and social isolation in male students, potentially contributing to increased dropout rates.

    The use of sexist language, lack of role models, and a biased curriculum all present barriers to the successful recruitment and retention of male students in schools of nursing and, subsequently, the profession. 

    Challenges to public perceptions regarding men in nursing, dedicated initiatives to increase the number of men in all levels of nursing academia, promotion of scholarly articles on gender diversity enrichment in nursing, and mentorship promotion in schools of nursing and workplaces are but a few of the Efforts recommended to dispel barriers, perceived or real, to men entering the nursing profession (Mac Williams et al., 2013). 

    Faculty need to be sensitive to the learning environment they create within the classroom, and ensure that it is inviting to all students. Avoiding sexist language in textbooks, tests, and lectures is essential. Male students can benefit from peer support groups and exposure to male nurse role models.

Veterans Entering Nursing

    Veterans who want to apply their Military Occupational Specialty after completing service to their nation have been faced with difficulties in transferring prior knowledge and skills into a professional nursing career. The Veterans Administration and HRSA have recently joined forces with schools of nursing to help make the transition from military service to nursing school a smoother and rewarding process. 

    The Helping Veterans Become Nurses Initiative is the result of a partnership between HRSA and several branches of the military (Army, Navy, Air Force) to align curriculum requirements in nursing programs with corpsmen and medics enlisted medical training to receive academic credit for military service in health care related fields (American Association of Colleges of Nursing, 2014c).

    Additional and specific initiatives and funding have been developed to transition veterans' skills into nursing careers. Nine geographically distinct colleges and universities have been award grants totaling $2.8 million over 4 years to enable up to 1000 veterans to enroll in and complete baccalaureate nursing degrees (HRSA, 2013a).

    In addition to the barriers researched and cataloged regarding men in nursing, veterans and the schools that enroll them are faced with additional potential issues that confront men and women as a result of military service. 

    Prior traumatic mental and physical experiences require veterans to re create themselves in a civilian world that has little insight into the challenges they may face entering college, deflecting beliefs toward the military, making personal connections to academic rigor and study requirements, or accessing resources to assist the former veterans to successfully complete their nursing program and transition into a professional career. 

    Faculty can best help veteran-students by their availability and mentorship, willingness to listen, helpfulness in navigating a “foreign” academic system, and guiding them to liaisons and others positioned to provide the additional assistance to success (Bowman, 2014; HRSA, 2013a ).

First Generation College Students

    Many students experience the stressors of being a college freshman during their first year in postsecondary academic studies. Traditional students who enter college directly from high school to college discover an environment vastly different from the one they experienced over the preceding 4 years. 

    In college, they need to create their own futures through self-directed academic activities amid a new social milieu. Some are easily dazed by the campus size, locating classes, purchasing books, arranging financial aid, understanding complex syllabi, balancing assignment calendars, and locating campus resources (Baker, 2010; Cohen, 2013; Shelton, 2012; Wright, 2012).

    During that first year, freshmen need to fine-tune study habits, develop time-management and test-taking skills, and generally adjust to the workload of college studies. However, the most significant transformation for students is their change in classic theory approaches to learning from dualism to multiplicity to relativism (Erickson & Strommer, 1991). 

    Initially, students see learning as either right or wrong (dualism), resulting in the belief that faculty know the truth and students merely absorb information to display knowledge during tests. 

    As students' progress in their studies, multiplicity in thinking develops whereby virtual truth in right or wrong gives way to opinion: faculty implant theoretical beliefs and students begin to think and respond to learning differently. The successful student eventually and, one hopes quickly, understands that thinking needs to be transformed by evidence and reasoning; hence, relativism.

    Imagine the same development as experienced by students who are the first in their families to attend a postsecondary institution. They have no family member or close relative who can mentor or counsel them through these different and difficult scenarios; they do not have family members who developed the self confidence to navigate the college experience and can relay that same confidence to them. 

    Postsecondary nursing programs and faculty can best assist first-generation students by developing student-centered environments that not only identify at-risk students but dedicate resources and personnel to assist them to successful program completion (Baker,2010; Cohen, 2013; Shelton, 2012 ; Wright, 2012).

Barriers That Affect the Success of Diverse Students

    Students with diverse backgrounds can face a number of barriers that hamper their ability to succeed in college. Cultural differences between and within student and faculty groups, the previously discussed gender and generational differences, and a lack of rigorous academic preparation are thought to contribute to the difficulty of teaching a diverse student body (Bednarz, Schim, & Doorenbos, 2010).

    The most common barriers are the lack of financial resources, academic preparedness, language skills, and role models among ethnically diverse faculty (Condon et al., 2013; Dapremont, 2014; Davis, Davis, & Williams, 2010; Igbo et al., 2011; Loftin, Newman, Dumas, Gilden, & Bond, 2012;

Lack of Financial Resources

    Financial problems are a major stressor for students. Rising tuition costs and other fees, coupled with a reduction in government support for higher education, affect all students. Financial concerns may be particularly difficult for minority students who are often the first in their family to seek higher education. 

    They often come from low-income households and therefore their families may lack the necessary financial resources to support their education. Financial aid in the form of loans or scholarships is becoming more competitive, and less money is available (Condon et al., 2013; Loftin et al., 2012).

Lack of Rigorous Academic Preparation

    Insufficient academic preparation and lack of support can also prevent students from completing their program of study. Many Latino youth attend elementary and secondary schools with few academic and physical resources and are thus not prepared for the academic challenges of a nursing program (Condon et al., 2013; Donnell, 2015; Shinn & Ofiesh, 2012; Torregosa, Ynalvez, Schiffman , & Morin, 2015).

    Many colleges offer special enrichment programs to help students achieve basic academic skills, as well as adjust to the college learning environment. Through academic advisement, skills assessment, and assistance with developing study skills, instructors can help students achieve a better academic record. 

    Through programs such as that of Lehman College in New York City (Georges, 2012), opportunities are created for individuals from disadvantaged backgrounds for precollege preparation, enrollment, retention, and student scholarships. Opportunities have included

(1) improvement in recruitment of disadvantaged students into health care careers

(2) development of a rigorous retention program

(3) provision of scholarships and education technologies to support academic success

(4) an increase of culturally competent, quality health care through the graduation of diverse nurses to provide services to diverse populations

    Another project, called Bring Diversity to Nursing (BDN), is supported by the University of Massachusetts–Lowell Department of Nursing and Bureau of Health Professions funding. BDN developed entrance requirement initiatives and middle and high school workshops; employed minority nurse recruiters; developed retention activities, including sociocultural activities; and summarized retention and success data (Devereaux-Melillo, Dowling, Qbdallah, Findeisen, & Knight, 2013).

Lack of Language Skills

    For many students, English is an additional language (EAL), and the students may speak English at school and another language at home. Most studies of EAL have examined Hispanic, Asian, and American Indian students, but ignored other significant immigrant African students. 

    Several studies have found that EAL students experience several barriers such as lack of self-confidence; reading, writing, and learning difficulties; isolation; prejudice; and lack of family and financial support (Shinn & Ofiesh, 2012).

Lack of Diverse Faculty

    There is a need to recruit more faculty from diverse racial, ethnic, and gender minorities. According to data from AACN member schools (2014b), only 12.3% of full time nursing faculty members come from minority backgrounds. 

    A lack of racial, ethnic, and gender diversity among faculty represented in nursing is a reflection of the failure to recruit and retain the same diversity in the undergraduate and graduate student population. Furthermore, the lack of ethnically diverse faculty can perpetuate a culture of insensitivity to the needs of those ethnically diverse students.

    Faculty need to embrace the cultural differences of their students and use available resources to foster a successful learning environment. Collaboration with ethnic student associations on campus could assist faculty to promote learning among their culturally diverse student population. 

    Furthermore, faculty could work to promote student success by offering access to role models, peer support and encouragement, tutoring opportunities, and communication strategies (Condon et al., 2013; Devereaux Melillo et al., 2013; Donnell, 2015; Shinn & Ofiesh, 2012; Torregosa et al., 2015).

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